Despite a growing volume of varied skin tones in the United States, the specialists charged with treating these contrasting pigments are lacking in color.
Dermatology is among the least ethnically and racially diverse specialties in medicine, a bleak fact that is becoming worse with time, said Dr. Andrew F. Alexis, chair of dermatology at Mount Sinai St. Luke’s and Mount Sinai West, New York.
“Simply put, the field of dermatology, with respect to the diversity of our workforce, is not keeping up with the diversity of the United States,” said Dr. Alexis, director of The Skin of Color Center of Mount Sinai St. Luke’s and Mount Sinai West.
Today, black dermatologists comprise 3% of all dermatologists, while 12.8% of Americans are black, according to a commentary coauthored by Dr. Alexis and published online in January in the Journal of the American Academy of Dermatology (J Am Acad Dermatol. 2016 Mar;74:584-7). Just over 4% of dermatologists are of Hispanic origin, compared with 16.3% of the general population. By 2060, the number of Hispanics is expected to rise to 129 million, comprising 31% of the population, while 15% of Americans will be black and 8.2% will be Asian, according to Census Bureau estimates.
A diverse dermatology workforce is critical to treating the increasing racial and ethnic makeup of patients, said Dr. Susan C. Taylor, co-founding director of The Skin of Color Center and a Philadelphia-based dermatologist. Studies show that race-concordant visits are longer and have higher ratings of patient satisfaction, according to the JAAD article. Data show that minority physicians are more likely to care for patients of their own race or ethnic group, practice in underserved areas, care for poor patients and those with Medicaid, and treat patients who report poor health status.
“It’s so important to make sure we have a diverse workforce,” Dr. Taylor said in an interview at the annual Skin of Color seminar, recently held in New York City. “Individuals with skin of color, when they’re trained in dermatology, they go back to their communities and really make a difference.”
The dearth of diverse dermatologists and the rising minority population are fueling renewed efforts by dermatology leaders to increase the racial and ethnic variance of their specialty.
“First and foremost, we must make the achievement of racial/ethnic diversity a goal for dermatology,” Dr. Alexis and his coauthors wrote in JAAD. “This is a call to action. The time is now.”
Lack of exposure, mentors spur problem
A number of reasons contribute to the lack of diversity in dermatology, said Dr. Bruce U. Wintroub, vice dean of the University of California, San Francisco, School of Medicine. A narrow pipeline starting early in education is one source of the problem, he said. A large proportion of minority students fail to move from high school to college and from college to medical school, leaving a smaller pool of diverse students heading to medical school.
In addition, “medical students from underrepresented populations do not chose dermatology as frequently as they chose other specialties,” said Dr. Wintroub, who chairs UCSF’s dermatology department. “The question is: Can we attract more of these medical students into dermatology, and how can we be more effective at that?”
Lack of exposure to dermatology leads many students to choose a different route, Dr. Taylor added. Often, medical students are not aware of dermatology as a specialty until they are far advanced in their training, she said. Dr. Taylor herself switched to dermatology after a 3-year internal medicine residency. Had she been exposed to dermatology at an earlier point in her education, she may have pursued the specialty sooner, she noted.
“It’s very important to enlighten and educate medical students about the importance of dermatology as a specialty and see if we can recruit them and interest them in dermatology,” Dr. Taylor said in the interview.
An absence of mentors for minority students throughout their schooling also drives the disparity, said Dr. Amit Pandya, chair of the American Academy of Dermatology Diversity Task Force and a dermatologist at the University of Texas Southwestern Medical Center, Dallas, who is the lead author of the January JAAD article.
“It’s not lack of bright students,” Dr. Pandya said in an interview. “They don’t have the mentorship many times, or the role models or people to guide them to” these areas.
Building diversity in dermatology
To address the gap, the AAD Diversity Task Force created the Diversity Mentorship Program, which provides a stipend to promising medical students from underrepresented backgrounds to spend 1 month with a dermatologist. The program aims to spark interest in the specialty.